The fees & rebates associated with your treatment will vary depending on individual requirements. Our administration staff are happy to give you an idea of approximate costs for differing treatments or surgeries before treatment begins. Consultation fees are payable on the day of the consultation, this includes WorkCover and Transport Accident Commission (TAC) patients. These fees may then be claimable through WorkCover insurers or the TAC.
Health insurance policies cover inpatient treatment, but not for consultations outside of hospital. We offer discounts to full pensioners, otherwise our fees reflect the AMA fee structure. Payments can be made at our clinic via EFTPOS, VISA, MASTERCARD, or cash. We can help you claim your Medicare rebate to be paid directly into your account.
Standard consultation fee: $175 – payable on the day (Medicare rebate of $72.75 is claimable).
Second opinion fee: $300 – payable on the day (Medicare rebate of $72.75 is claimable).
This fee is only used where major surgery has been recently undertaken.
Review appointment fee: $90 – payable on the day (Medicare rebate of $36.55)
This fee may not apply during the “aftercare” treatment of surgery. For example, joint replacement surgery includes six weeks of aftercare.
Our surgical costs are based around the Australian Medical Association (AMA) fee schedules. You and your surgeon will discuss the anticipated surgical costs. Private health insurance doesn’t mean no out of pocket expenses – but we are committed to help you understand these expenses.
Other costs to budget for include the Hospital, the Anaesthetist, a Physician if involved, the Surgical Assistant, Pathology, Radiology, Physiotherapy, and sometimes others. The range of fees depend on your insurance policy, but we find many insurers talk of “Top Cover” which doesn’t cover the AMA fee.
Check your policy allows private hospital treatment, and doesn’t exclude certain treatments such as joint replacements. We find insurers talk of “Top Cover” however this means vastly different things with different insurance companies.
You may need to pay gaps to the hospital, anaesthetist, assistant surgeon, and surgeon totalling between $800 and $4000 for standard treatments. Our administrative team will check your insurance policy while organising your admission to ensure no surprises.
Not all insurance policies cover Private Hospitals. We do not have the same access to beds & operating lists in Public Hospitals as we comply with the principle of “Treat In Turn”. In Public Hospitals, we are obliged to treat patients in the order they are put on the waiting list for surgery.
There is still an advantage to patients being private rather than public patients.
Out of pocket expenses may apply, as above, but may be less if the hospital chooses not to ask for your “excess” payment. Because of the limitation of this resource, we do not advocate patients with full insurance using this option. St John of God carries advantages including a predominance of single rooms, and Ultra Clean Ventilation in the operating theatres. Some patients with this lower level of insurance still choose surgery at St John of God, and accept higher hospital expenses.
Firstly, don’t take a financial risk, assumptions that surgery will allow you to return to the workforce are sometimes wrong. All Surgeons at Ballarat Orthopaedics have a public appointment at Ballarat Base Hospital, where free treatment is available. Should you wish to pursue free treatment, please ask your GP to refer you to Ballarat Health Services Outpatients Department.
Our private practice, including our private consulting rooms, is for patients paying a fee for services delivered. Consulting fees don’t cover our costs, so we do not see uninsured patient with a view to putting their name on the public hospital waiting list. We are happy to see uninsured patients if they are seeking private surgical treatment at the hospitals we attend.
To understand the cost of surgical treatment – it is important to understand the surgeon’s fee is only a small part. Other costs include the hospital, any surgical implants (eg knee replacement), anaesthetists, assistant, radiology, and pathology.
Your total cost (not just the surgeon) AFTER Medicare could approximate:
Knee arthroscopy (eg cartilage operation) – $3,700
Knee cruciate ligament reconstruction – $5,200*
Shoulder surgery (cuff tear or instability) – $7,000*
Hip or Knee replacement – $17 000
* Physiotherapy not included in this figure.
It may be possible to have a small saving by having private surgery in a public hospital, but the financial benefit is very small. The majority of our patients are able to walk and be back home within a day or so of joint replacement surgery. Private uninsured patients having treatment in a hospital are required to pay for implants and other expenses PRIOR to admission.
All information here is given as true and correct as of the date of publication (June 2017). If you have any queries, please contact our clinic.
What is junk insurance?
Junk health insurance is a term used to describe a health fund policy or plan that has so many exclusions, it is virtually useless in a private hospital setting. Many patients only realise that they have junk insurance after being advised by their doctor that they need urgent medical treatment which may include surgery. As this graph below shows, the number of health insurance policies with exclusions has risen significantly over the last 10 years.
Proportion of policies with exclusions and insured persons covered, 2004 to 2016 Ref: APHA Information Paper, Private Health Insurance March Quarter 2016, p.11
What to do
For further information, see www.privatehealth.gov.au
If we have not answered your question well enough on this page or if you have a question which is not covered please get in contact with your doctor.